Ecstasy (MDMA) toxicity: Difference between revisions
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*ABCs | *ABCs | ||
*IV, O2, monitor | *IV, O2, monitor | ||
*Agitation | *Agitation | ||
*Seizure: | **benzos | ||
*Seizure AND | **haldol | ||
*Hyponatremia: | *Seizure: | ||
*Hyperthermia: | **benzos | ||
*Rhabdo | **phenobarbital (20mg/kg), propofol | ||
**avoid dilantin | |||
**manage airway as indicated | |||
*Seizure AND Hyponatremia | |||
**hypertonic saline (3% NS) 2-3 ml/kg IV | |||
***bolus until sz stops (need to raise serum Na by 3-5 meq/L) | |||
*Hyponatremia: | |||
**fluids restrict most pt's, unless hypovolemic. correct Na slowly: 0.5 meq/h; 10-12 meq/24h | |||
*Hyperthermia: | |||
**ice packs, cold IVF, consider dantrolene 1mg/kg IV | |||
*Rhabdo | |||
**foley, IVF | |||
==Disposition== | ==Disposition== | ||
Revision as of 18:37, 14 September 2012
Background
- 3,4-methylenedioxymethamphetamine (MDMA)
- other names: E, X, XTC, Adam, Stacy
- causes catecholamine release, serotonin release, and inhibits serotonin re-uptake
- "rave" parties
- 1-2 mg/kg effective dose; onset 30min-1 hour, peak 4 hours, lasts 8-24 hours
- typical tablets contain 50-100mg of ecstatsy (although other substances possible)
Clinical Features
- most people report euphoria
- AMS
- agitation
- tachycardia, palpitations, HTN
- serotonin syndrome (AMS, hyperthermia, rigidity, autonomic instability)
- GI symptoms
- dehydration
- bruxism (jaw clenching/grinding)
- hyperthermia
- hyponatremia (from sweat loss, free water intake, and SIADH like effect)
- seizure
- mydriasis
- hepatotoxicity
Workup
- Accucheck, ISTAT
- urine pregnancy
- CBC, BMP, LFTs, coags, tylenol, aspirin
- CK
- ECG
- UA
- Tox screen, blood alcohol
- serum osmoles, urine Na (if hyponatremia present)
- Head CT as indicated
- LP as indicated to rule out meningitis
Treatment
- ABCs
- IV, O2, monitor
- Agitation
- benzos
- haldol
- Seizure:
- benzos
- phenobarbital (20mg/kg), propofol
- avoid dilantin
- manage airway as indicated
- Seizure AND Hyponatremia
- hypertonic saline (3% NS) 2-3 ml/kg IV
- bolus until sz stops (need to raise serum Na by 3-5 meq/L)
- hypertonic saline (3% NS) 2-3 ml/kg IV
- Hyponatremia:
- fluids restrict most pt's, unless hypovolemic. correct Na slowly: 0.5 meq/h; 10-12 meq/24h
- Hyperthermia:
- ice packs, cold IVF, consider dantrolene 1mg/kg IV
- Rhabdo
- foley, IVF
Disposition
- Admit pt's with complications of ingestion
- Discharge those who are asymptomatic and no life threatening complication
Sources
Harwood-Nuss, Rosens, EMedicine